Disparities, way forward for region’s healthcare systems

Dr Katlego Mothudi CorrespondentSince their independence, the governments of many countries in
Southern African were able to increase access to health services, but
the quality of healthcare provided remains a challenge, and there are
disparities in the quality and extent of healthcare services accessed
between the rich and poor.

Universal Health Coverage (UHC) presents a plausible solution to
addressing many of these challenges, but perceptions remain that UHC
will be too costly.

Many countries with limited resources have, however, shown that a lot
can still be done with these limitations. They have also shown that
political will and strong leadership are key to the successful
implementation of UHC.

The upcoming 20th Annual BHF Conference to be held in Cape Town,
South Africa from July 21-24, 2019, will focus on implementation of the
healthcare systems of the future, as we look towards 2030 and the
healthcare targets set out in the United Nations’ Sustainable
Development Goals (SDGs).

Regional challenges to be addressed

as we look towards 2030

Healthcare needs to be reshaped so that, 11 years from now, we do not
sit with the same challenges and discussions around what should be done
to improve the region’s healthcare status.

Issues around infant mortality and the burden of communicable
diseases continue to affect progress in healthcare systems across the
region. In Namibia, for example the maternal mortality rate has almost
doubled since 2000, according to UNICEF.

Neonatal mortality was also high at 35,1 deaths per 1 000 live births
in 2015, having increased from 19 deaths per 1 000 live births in 2010.

While progress has been made in some areas, it has been thwarted by a
lack of capacity and resources at the decentralised level. A number of
countries battle to address and maintain the World Health Organisation’s
six crucial healthcare pillars i.e. human resources for health (HRH),
infrastructure, medicines and technology, health financing, health
information systems (HIS) as well as leadership and governance.

Human resources remain a major challenge. A number of countries
continue to battle with HRH strategic planning. A lack of integrated HRH
information systems, poor HRH governance and ineffective operational
management hamper progress.

While South Africa ranks among the top five countries in Africa in
terms of the number of physicians, nurses and midwifery personnel, the
country continues to battle with delivery of services in the public
sector.

Gaps in healthcare provision between countries, and within individual
countries in the region, continue to widen due to factors such as
inequalities in embracing modern technologies and unequal distribution
of new healthcare solutions.

The organisational structure of national health information systems
is fragmented, which makes it difficult to incorporate diverse data
sources and to compile proper documentation.

Finance remains a critical issue, as many countries still depend on
donor funding. This has created a long-term problem of sustainability.
Donor funding has improved the lives of the poor in a number of
countries.

Governments must, however, take responsibility for their countries’
healthcare programmes to ensure that they can be sustained, with or
without donor funding. This is of particular concern because of the
increasing burden of disease. New and re-emerging diseases continue to
restrain effective service delivery.

Re-imagining the future healthcare system

In the countries that have implemented universal health coverage like
Ghana, Zambia, Rwanda, Cameron and Uganda, the lessons learnt are that
without political will it would be difficult to implement and sustain
it.

The popular perception is that funding will enable the success of
universal health coverage, but it’s strong leadership and political
will, coupled with good governance structures and an effective legal
framework that will enable its success.

In Egypt, Rwanda South Korea and Thailand, universal health coverage
has been implemented with limited resources. The lessons learnt there
can be used as a starting point to kick-start efforts towards UHC in the
region.

UHC planning and implementation must be led from the front. Political
leaders have to prioritise UHC if the sustainable development goals on
health are to be met. The focus has to be on attaining a one
country-one-country healthcare model.

Looking ahead

In a fragmented healthcare structure, collaboration remains critical.
The health outcome targets set in healthcare for the public sector,
must also be embraced by the private sector.

Any dialogue around the SDGs should include inter-sectoral
discussions and collaboration. The diversity of healthcare systems
across Southern Africa means that all stakeholders including healthcare
practitioners, beneficiaries, employers and governments are needed to
bring about improvement.

New technology, cognisant of the fourth industrial revolution, is needed to co-ordinate efforts.

With just 11 years to the 2030 SDG deadline, it has become clear that
there has been enough discussion around challenges. We need solutions
and proposals on what needs to be done.

Eighty-four percent of people in South Africa continue to face
healthcare discrimination based on affordability, the figure is
estimated to be slightly higher across Southern Africa.

These are people who cannot enjoy the same access to healthcare as
those who can afford it and we cannot continue on this trajectory.

The 20th Annual BHF Conference at the International Convention Centre, Cape Town will focus on these issues.

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